Portfolio Adviser • PA May 2019 • Sector Report

Speaking at the World Economic Forum in Davos in January 2019, health secretary Matt Hancock made the case for antimicrobial resistance (AMR) to be regarded as a global health emergency. He outlined the UK’s 20-year plan to cut the unnecessary prescription of antibiotics and reduce the number of drug-resistant infections.

Prior to the discovery and refinement of antibiotics, there was a strong likelihood the simplest of bacterial infections could prove fatal.

Surgical procedures, communicable diseases such as tuberculosis and even childbirth all presented serious infection risks that were largely untreatable in the pre-antibiotic age.

Accepting his share of the Nobel Prize in Physiology or Medicine in 1945 for his discovery of benzylpenicillin 17 years earlier, Sir Alexander Fleming acknowledged its phenomenal success in saving lives – but he also delivered a warning.

Fleming said an intelligent and cautious use of antibiotics would be necessary to maintain their effectiveness. Unfortunately, that warning has largely gone unheeded.

Widespread overprescription has enabled infectious bacteria to evolve and strengthen their resistance to antibiotics. Consequently, AMR is now recognised as one of the most significant threats to public health today, as existing treatments become ineffective and bacteria quickly develop resilience to new formulas.

In 2013, federal health officials in the US estimated that at least 23,000 Americans a year were dying from antibiotic-resistant infections. Six years previously, the Centers for Disease Control and Prevention determined that about 100,000 were dying annually from infections caught in hospitals.

The threat posed by AMR becomes clearer with the understanding of how bacteria function and proliferate. It’s estimated that the human body contains around 100 trillion bacterial cells, many of which function to keep us well. Many others, however, can cause sickness and have done so throughout human history.

In 2008, the human tuberculosis strain was discovered in a 9,000-year-old Neolithic burial site submerged in the Mediterranean. Bacteria are both durable and highly adaptable with an extraordinary capacity to reproduce singular or ‘block’ alterations and resistances.

Beyond our failings as patients to complete antibiotic courses, we can also point to the widespread prescription of antibiotics for drug-resistant illnesses.

In some countries, the World Health Organisation estimates around 80% of medically important antibiotic stocks are used to promote growth in otherwise healthy animals.

Finance is also a factor in reduced antibiotic efficiency as research costs are extremely high for next-generation medicines. As such, pharmaceutical giants are often reluctant to push forward into later stages of development and trial.

In response, science is turning back to nature for new and robust antibiotic treatments.

Selman Waksman, a microbiologist who coined the term ‘antibiotic’ in 1942, spent many years researching soil microbes, discovering at least 20 antibiotic strains, including the first effective treatment for tuberculosis: streptomycin.

In 2015, researchers from Northeastern University in Boston and NovoBiotic Pharmaceuticals isolated the antibiotic teixobactin from soil samples that has so far withstood AMR.

Answering a UN call for action in 2016, a coalition of pharmaceutical companies and associations formed the AMR Industry Alliance to develop sustainable solutions to combat antimicrobial resistance.

Agreeing to a common framework, more than 100 biotech and biopharma signatories from 20 countries pledged to reduce AMR by 2020, by limiting the environmental impact of manufacturing, addressing antibiotic misuse and supporting collaborative research and development.

Leading pharmaceutical companies are also adopting this framework and are being assessed on their efforts.

In January 2018, the Access to Medicine Foundation published its inaugural Antimicrobial Resistance Benchmark, with Glaxosmithkline and Johnson & Johnson coming top among the larger research-based firms.

Glaxosmithkline has the most antimicrobial medicines currently under development and is one of only two companies in the benchmark fully separating sales incentives from the volume of antibiotics sold.

Johnson & Johnson is ensuring access to its breakthrough multi-drug resistant tuberculosis treatment is controlled through national programmes.

A key feature of the benchmark is a continuous assessment of post-distribution stewardship. It looks at how well companies are educating healthcare professionals and dispensers of antibiotic prescription and use, and how effective they are at supporting efforts to monitor antibiotic resistance.

Professor Dame Sally Davies, chief medical officer for England and co-convenor of the UN inter-agency co-ordination group on AMR, said: “This independent Antimicrobial Resistance Benchmark is a huge step forward and shines a light on the pharmaceutical industry’s progress in tackling drug-resistant infections.

“It can help pave the way for a fast, transparent learning culture where best practice is shared, progress celebrated and gaps where further work is needed are identified.”

Collaboration, innovative research and the drive for more responsible antibiotic use may not defeat microbial infection entirely, but together they may help medicine to regain the upper hand.

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